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In the last post, we saw how:

• Men and women are affected by schizophrenia at the same rate. The reproducibility among those who have the condition has increased over time.

• Most of the caregivers in the study believed in supernatural causes of schizophrenia.

• The treatment of acute mania is typically with antipsychotics and benzodiazepines.

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Welcome to Medic Vibes, where we discuss mental health disorders and make sense of them. Dr Ebingo Kigigha is a medical doctor (aspiring psychiatrist) and creative person (illustration and music). This has been our routine for three consecutive months. This month will be dedicated to Schizophrenia. In the first month, we discussed Depression, and in the subsequent month, anxiety. We just finished with Bipolar affective disorder. We are done looking at research work done in Nigeria on schizophrenia.

In this post, we are looking at this study that talks about Beliefs About the Cause of Schizophrenia Among Caregivers in Midwestern Nigeria. To learn more just keep scrolling down. You can also skip to the key point of the post if you which or go to the conclusion to get the summary.

Epidemiology (Medial conditions)
Medical Conditions
Those who are schizophrenic die more from an accident than other people. They also die from natural causes. It is thought to be a result of the difficulty in treating medical and surgical conditions in schizophrenic patients. It has been found that 4 out of 5 patients with schizophrenia have medical problems and half of them are not diagnosed.

Discussion

People illustrations by Storyset

This is the first study of its kind done in Midwestern Nigeria that brings to light the thoughts on the cause of schizophrenia among the relatives of those who have the condition. The previous studies were more inclined toward the general population. The study was able to clarify the findings in other parts of the country that have found the same thoughts from caregivers about the condition.

One study in southwestern Nigeria saw that most people attributed the cause to natural rather than supernatural causes as seen in this study. This other study had Christian theology involving the devil as a cause and also the bad wishes of those who hate the patient as a second cause. The natural causes that were endorsed in this study were brain injury and familial inheritance. This is in keeping with the finding that most developing countries attribute mental illness to supernatural causes.

Noticeably, those who believed that the cause was due to the natural cause were more likely to follow the treatment prescribed than those who had thought otherwise. In the general population of those in the South West, the cause is also attributed to supernatural causes. This belief system was also a cause for delays in reporting to healthcare facilities. Adeosun’s study saw that close to 70% of the patients would seek help from healers than go to the hospital. Those who sought hospital care were only 30%. This is a finding that is probably seen in almost every community in Nigeria.

The treatment of choice is usually that which is closest to the beliefs of the population. When this type of belief dominates in society, it worse the prognosis and prolongs the treatment period for most mental illnesses.

Aghukwa’s study in Northern Nigeria shows that 70% of those who believed the cause of the mental illness was spiritual went to the hospital after 5 years of the condition affecting the patient. Almost a similar percentage of people who received care within the first 6 months of the illness began. This shows that belief in supernatural causes has a negative correlation to medical treatment.

This belief in the spiritual has a specific negative relationship with following treatment. Ayorinde found that spirit healers were a more acceptable means of treatment. Commanding Nigerians and British younger populations belief, found that more younger Nigerians believed in supernatural causes when compared to the British population.

In this stud, married people were more likely to believe in the biological causes of schizophrenia and the widowed/divorced had a belief in the natural causes compared to others. Those who were caregivers to male patients were also more likely to believe in the natural causes when compared to those who cared for female patients. No one is quite sure of the reason for this finding. Some scientists attribute it to the thought that a male child may be more important than is seen in society. To support this belief is the fact that people are more likely to spend money on the treatment of male patients when compared to females. Some speculate that the reason they believe in the natural was probably that the male patients started to get better after treatment.

In this study, there was also a relationship between the mean age and the belief in the supernatural.

A noticeable information was that all caregivers who were not educated all believed that the supernatural was the cause of schizophrenia compared to 84% as seen in those who were educated. It was also very surprising to see that most of those who were educated believed in the supernatural. The second most common belief among those that were educated was natural causes. It was also seen in the South Western Study. This makes for a valid argument about beliefs being affected by education.

In Pakistan, there was just about a third of people who belied in a natural cause were educated adding to the possibility that education does not affect the thoughts on the causation of schizophrenia. Ikwuka and collages’ study showed the opposite in relation to the educated as regards schizophrenia. Their viewpoint was that western education had a better outcome in belief in the natural causes of schizophrenia. Ikwuka's study found that younger people believed more in natural causes and found this to be related to the fact that older people hold on to older traditional beliefs as they age.

Treatment

Stabilizing and Maintenance
In this phase of treatment, the condition is gradually remitting and showing up less. Maintenance is done so the condition does not reappear and helps the patient to be back to being a functional part of society. The new medication has come with less tardive dyskinesia this is good news this symptom doesn’t need special attention. Once patients get to this point they are almost having no symptoms. Taking the patient off the medication can lead to relapse.

Less than 35% of patients who are on maintenance will relapse while close to 80% of those who are not on maintenance will relapse in a year. Those who then have one relapse are more likely to have one more within the next 5 years. This multiple the risk by 5.

Of particular importance is the duration of maintenance after the first episode. Some manuals suggest 1 to 2 years. This is very important especially when it relates to those who are schooling or working because they could be a lot of stigmas directed towards them if they have an episode.

The problem with long-term therapy is that it can lead to the patient not compiling with therapy. About half of the patients on therapy are non-compliant for a year or two. Usually, patients are more compliant when they receive long-acting medication.

It is necessary to place the patient on oral supplements while building up the blood levels of the drug. Some of the long-acting drugs given through the parenteral route are Fluphenazine and haloperidol. Other less-used drugs are olanzapine, risperidone and aripiprazole.

In addition to the complaint seen in long-acting injected medication, there are also fewer changes in blood levels and it is easier to remember to take medications when they are.

Questions

• What did you learn about Schizophrenia?

Conclusion

• Schizophrics are more likely to suffer from medical conditions than the general population.

• There are many talking points to be discussed in this study, top on the list is the relationship between education and belief in aetiology in schizophrenia.

• Maintance prevents relapse in most patients and has been effective.

References

• Kaplan-Sadocks-Comprehensive-Textbook-Psychiatry
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• NCBI